Association Between Cardiologist Ambulatory Workload and Evidence‐Based Therapy for Heart Failure
10 affiliations
- 1NYU Grossman School of Medicine
- 2Optimal Aging Institute, NYU Grossman School of Medicine
- 3University of Wisconsin School of Medicine and Public Health
- 4Karolinska Institute
- 5Danderyd Hospital
- 6Geisinger
- 7NYC Health+Hospitals/Bellevue
- 8Tufts Medical Center
- 9Johns Hopkins Bloomberg School of Public Health
- 10NYU Grossman Long Island School of Medicine
Abstract
Background Most eligible patients are not prescribed guideline‐directed medical therapy for heart failure with reduced ejection fraction (EF). Increased time pressures for providers in the ambulatory setting may contribute to these shortfalls. We assessed the association between cardiologist ambulatory workload and guideline‐directed medical therapy prescription for patients with heart failure with reduced EF. Methods This was a cross‐sectional study of patients with heart failure with reduced EF (EF ≤40%) seen by a cardiologist from October 1, 2022, to September 30, 2023, using deidentified administrative and electronic health record data from Optum Labs Data Warehouse, which includes data from multiple health systems across the United States. The primary exposure was ambulatory workload, measured as the average number of visits per day, categorized into quartiles. The primary outcome was “comprehensive quadruple therapy,” defined as prescription for all 4 guideline‐directed medical therapies: β‐blocker; angiotensin receptor–neprilysin inhibitor; mineralocorticoid receptor antagonist; and sodium‐glucose cotransporter 2 inhibitor. Analyses were conducted using generalized estimating equations, adjusted for demographic and clinical variables. Results Overall, 40 173 patients were seen by 881 cardiologists (median ambulatory workload, 9.1 patients per day; interquartile range=5.1–13.0). The percentage of patients prescribed comprehensive quadruple therapy was higher among patients in lower quartiles (quartile 1: 14%; quartile 2: 9.7%; quartile 3: 8.9%; quartile 4: 7.4%; P<0.001). In adjusted analysis, there was a graded association between lower workload quartile and higher odds of comprehensive quadruple therapy, compared with the highest quartile (odds ratio [95% CI], P value=quartile 1: 1.35 [1.09–1.66], 0.008; quartile 2: 1.20 [1.00–1.43], 0.050; quartile 3: 1.11 [0.93–1.32], 0.28; quartile 4 [reference]). Conclusions Seeing a cardiologist with lower ambulatory workload was associated with increased prescribing of guideline‐recommended, life‐saving therapy in patients with heart failure with reduced EF. Current models that incentivize more visits per day may negatively impact care in the ambulatory setting.
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BibTeX
@article{mukhopadhyay2026association,
title = {{Association Between Cardiologist Ambulatory Workload and Evidence‐Based Therapy for Heart Failure}},
author = {Amrita Mukhopadhyay and Yingying Sang and Saul Blecker and Matthew F. Blum and Juan‐Jesus Carrero and Alexander R. Chang and Karan R. Chhabra and Anne‐Laure Faucon and Leora I. Horwitz and Lesley A. Inker and Jung‐Im Shin and Donglan Stacy Zhang and Morgan E. Grams},
journal = {Journal of the American Heart Association},
year = {2026},
month = oct,
doi = {10.1161/jaha.125.048608},
url = {https://www.ahajournals.org/doi/10.1161/JAHA.125.048608},
note = {CC BY},
}
RIS
TY - JOUR
TI - Association Between Cardiologist Ambulatory Workload and Evidence‐Based Therapy for Heart Failure
AU - Amrita Mukhopadhyay
AU - Yingying Sang
AU - Saul Blecker
AU - Matthew F. Blum
AU - Juan‐Jesus Carrero
AU - Alexander R. Chang
AU - Karan R. Chhabra
AU - Anne‐Laure Faucon
AU - Leora I. Horwitz
AU - Lesley A. Inker
AU - Jung‐Im Shin
AU - Donglan Stacy Zhang
AU - Morgan E. Grams
PY - 2026
DA - 2026/10/30
JO - Journal of the American Heart Association
DO - 10.1161/jaha.125.048608
UR - https://www.ahajournals.org/doi/10.1161/JAHA.125.048608
AB - Background Most eligible patients are not prescribed guideline‐directed medical therapy for heart failure with reduced ejection fraction (EF). Increased time pressures for providers in the ambulatory setting may contribute to these shortfalls. We assessed the association between cardiologist ambulatory workload and guideline‐directed medical therapy prescription for patients with heart failure with reduced EF. Methods This was a cross‐sectional study of patients with heart failure with reduced EF (EF ≤40%) seen by a cardiologist from October 1, 2022, to September 30, 2023, using deidentified administrative and electronic health record data from Optum Labs Data Warehouse, which includes data from multiple health systems across the United States. The primary exposure was ambulatory workload, measured as the average number of visits per day, categorized into quartiles. The primary outcome was “comprehensive quadruple therapy,” defined as prescription for all 4 guideline‐directed medical therapies: β‐blocker; angiotensin receptor–neprilysin inhibitor; mineralocorticoid receptor antagonist; and sodium‐glucose cotransporter 2 inhibitor. Analyses were conducted using generalized estimating equations, adjusted for demographic and clinical variables. Results Overall, 40 173 patients were seen by 881 cardiologists (median ambulatory workload, 9.1 patients per day; interquartile range=5.1–13.0). The percentage of patients prescribed comprehensive quadruple therapy was higher among patients in lower quartiles (quartile 1: 14%; quartile 2: 9.7%; quartile 3: 8.9%; quartile 4: 7.4%; P<0.001). In adjusted analysis, there was a graded association between lower workload quartile and higher odds of comprehensive quadruple therapy, compared with the highest quartile (odds ratio [95% CI], P value=quartile 1: 1.35 [1.09–1.66], 0.008; quartile 2: 1.20 [1.00–1.43], 0.050; quartile 3: 1.11 [0.93–1.32], 0.28; quartile 4 [reference]). Conclusions Seeing a cardiologist with lower ambulatory workload was associated with increased prescribing of guideline‐recommended, life‐saving therapy in patients with heart failure with reduced EF. Current models that incentivize more visits per day may negatively impact care in the ambulatory setting.
SN - 2047-9980
ER -